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90_SB0711
5 ILCS 375/6.9 new
30 ILCS 805/8.21 new
55 ILCS 5/5-1069.3 new
65 ILCS 5/10-4-2.3
105 ILCS 5/10-22.3f new
215 ILCS 5/356t new
215 ILCS 125/4-6.5 new
215 ILCS 130/4002.2
215 ILCS 165/10 from Ch. 32, par. 604
305 ILCS 5/5-16.8 new
Amends the State Employees Group Insurance Law of 1971,
Counties Code, Illinois Municipal Code, School Code, Illinois
Insurance Code, Health Maintenance Organization Act, Limited
Health Service Organization Act, Voluntary Health Services
Plans Act, and Illinois Public Aid Code. Requires coverage
under those Acts for a minimum of 96 hours of inpatient care
following a mastectomy. Permits a shorter inpatient care
period if certain criteria are met. Amends the State
Mandates Act to provide that reimbursement for
post-mastectomy care benefits is not required under that Act.
SRS90SB0037MNbm
SRS90SB0037MNbm
1 AN ACT concerning certain surgical procedures, amending
2 named Acts.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The State Employees Group Insurance Act of
6 1971 is amended by adding Section 6.9 as follows:
7 (5 ILCS 375/6.9 new)
8 Sec. 6.9. Post-mastectomy care. The program of health
9 benefits shall provide the post-mastectomy care benefits
10 required to be covered by a policy of accident and health
11 insurance under Section 356t of the Illinois Insurance Code.
12 Section 10. The State Mandates Act is amended by adding
13 Section 8.21 as follows:
14 (30 ILCS 805/8.21 new)
15 Sec. 8.21. Exempt mandate. Notwithstanding Sections 6
16 and 8 of this Act, no reimbursement by the State is required
17 for the implementation of any mandate created by this
18 amendatory Act of 1997.
19 Section 15. The Counties Code is amended by adding
20 Section 5-1069.3 as follows:
21 (55 ILCS 5/5-1069.3 new)
22 Sec. 5-1069.3. Post-mastectomy care. If a county,
23 including a home rule county, is a self-insurer for purposes
24 of providing health insurance coverage for its employees, the
25 coverage shall include coverage for the post-mastectomy care
26 benefits required to be covered by a policy of accident and
27 health insurance under Section 356t of the Illinois Insurance
-2- SRS90SB0037MNbm
1 Code. The requirement that post-mastectomy care be covered
2 as provided in this Section is an exclusive power and
3 function of the State and is a denial and limitation under
4 Article VII, Section 6, subsection (h) of the Illinois
5 Constitution. A home rule county to which this Section
6 applies must comply with every provision of this Section.
7 Section 20. The Illinois Municipal Code is amended by
8 adding Section 10-4-2.3 as follows:
9 (65 ILCS 5/10-4-2.3 new)
10 Sec. 10-4-2.3. Post-mastectomy care. If a municipality,
11 including a home rule municipality, is a self-insurer for
12 purposes of providing health insurance coverage for its
13 employees, the coverage shall include coverage for the
14 post-mastectomy care benefits required to be covered by a
15 policy of accident and health insurance under Section 356t of
16 the Illinois Insurance Code. The requirement that
17 post-mastectomy care be covered as provided in this Section
18 is an exclusive power and function of the State and is a
19 denial and limitation under Article VII, Section 6,
20 subsection (h) of the Illinois Constitution. A home rule
21 municipality to which this Section applies must comply with
22 every provision of this Section.
23 Section 25. The School Code is amended by adding Section
24 10-22.3f as follows:
25 (105 ILCS 5/10-22.3f new)
26 Sec. 10-22.3f. Post-mastectomy care. Insurance
27 protection and benefits for employees shall provide the
28 post-mastectomy care benefits required to be covered by a
29 policy of accident and health insurance under Section 356t of
30 the Illinois Insurance Code.
-3- SRS90SB0037MNbm
1 Section 30. The Illinois Insurance Code is amended by
2 adding Section 356t as follows:
3 (215 ILCS 5/356t new)
4 Sec. 356t. Post-mastectomy care.
5 (a) An individual or group policy of accident and health
6 insurance that provides surgical coverage and is amended,
7 delivered, issued, or renewed after the effective date of
8 this amendatory Act of 1997 shall provide coverage for a
9 minimum of 96 hours of inpatient care following a mastectomy,
10 except as otherwise provided in this Section.
11 (b) A shorter length of hospital inpatient stay for
12 services related to a mastectomy may be provided if the
13 attending physician is a physician licensed to practice
14 medicine in all of its branches and determines, in accordance
15 with the protocols and guidelines developed by the American
16 College of Surgeons, that the patient meets the appropriate
17 guidelines for that length of stay based upon evaluation of
18 the patient and the coverage for and availability of a
19 post-discharge physician office visit or in-home nurse visit
20 to verify the condition of the patient in the first 48 hours
21 after discharge.
22 Section 35. The Health Maintenance Organization Act is
23 amended by adding Section 4-6.5 as follows:
24 (215 ILCS 125/4-6.5 new)
25 Sec. 4-6.5. Post-mastectomy care. A health maintenance
26 organization is subject to the provisions of Section 356t of
27 the Illinois Insurance Code.
28 Section 40. The Limited Health Service Organization Act
29 is amended by adding Section 4002.2 as follows:
-4- SRS90SB0037MNbm
1 (215 ILCS 130/4002.2 new)
2 Sec. 4002.2. Post-mastectomy care. Limited health
3 service organizations are subject to the provisions of
4 Section 356t of the Illinois Insurance Code.
5 Section 45. The Voluntary Health Services Plans Act is
6 amended by changing Section 10 as follows:
7 (215 ILCS 165/10) (from Ch. 32, par. 604)
8 Sec. 10. Application of Insurance Code provisions.
9 Health services plan corporations and all persons interested
10 therein or dealing therewith shall be subject to the
11 provisions of Article XII 1/2 and Sections 3.1, 133, 140,
12 143, 143c, 149, 354, 355.2, 356r, 356t, 367.2, 401, 401.1,
13 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) and
14 (15) of Section 367 of the Illinois Insurance Code.
15 (Source: P.A. 89-514, eff. 7-17-96.)
16 Section 50. The Illinois Public Aid Code is amended by
17 adding Section 5-16.8 as follows:
18 (305 ILCS 5/5-16.8 new)
19 Sec. 5-16.8. Post-mastectomy care. The medical
20 assistance program shall provide the post-mastectomy care
21 benefits required to be covered by a policy of accident and
22 health insurance under Section 356t of the Illinois Insurance
23 Code.